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10040139 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 921 LIBERTY CT CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10040139 OWNER'S NAME: PETER WANG DATE ISSUED:04/22/2010 PER'S PHONE: 4082537271 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT PLUMB License Class Lic.# � i .� l MECH RESIDENTIAL f- COMMERCIAL Contractor��ti/c�� /�il��.+G��s�I�FJ/�ate %tom=''� JOB DESCRIPTION:REMV EXSTNG ROOFING INSTALL 2 SKYLIGHT OPENING I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions &2 Code and that m license is in full force and effect. SUNTUNNELS,REROOF W/COMP&REMV EXISTING Y INSULATION&REPLC W/R-30 BATT INSULATION CLASS A I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$15000 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35611064.00 Occupancy Type: correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source re tions r the Cupertino Municipal Code,Section 180 D F AST CALLED INSPECTION. 9.18. gu13 i ^� Signature -- Date`=i ,�^ Issued by ✓ 7Date: V OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must , Owner-er�uth yi�ed agent: forthwith comply with such provisions or this permit shall be deemed revoked. C, Date: " - YC' P APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name i •nify and keep harmless the City of Cupertino against liabilities,judgments, k and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulatio s per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. �;--_�� , / I understand my plans shall be used as public records. Signature ! ` Date Licensed Professional C� CITY OF ,,`GCS�/ �-%� �� &ML CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION APN# Date: Building Address: Owner's Name: AIX ,,l Phone #: HOA: Yes ❑ No IfYes, provide letter from HOA 17 Contractor: Phone #: X Fax#: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: • Built-Up Roof uBuilt-Up roof • Asphalt Shingles sphalt Shingles • Wood Shakes o Wood Shakes • Wood Shingles o Wood Shingles • Other(Specify) z.�,ngr'�7 o Other (Specify) Number of existing coverings o Provide I.C.C.E.S. Report# u To be Removed u Provide Mfgr. Installation Specs. Job Description: YV 1:3411-111,1 - Residential Commercial L] Green Building: Please complete relevant portion of the Confirmed with-Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: El applicable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO REROOF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMIC0 Seismic Commercial B / 1REROOFRES Re-roof Residential B 1SFDWLR00F I 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 BUSLIC Business License B REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 •FAX(408)777-3333 • buildina(d_)cupertino.org [I mi / A PROJECT ADDRESS '12-1 L/� / �� APN# OWNER NAME -TyJ , `✓�^ PHONE �+ ,�'+/ E-MAIL STREET ADDRESS, / `^ i CITY, STATE,ZIP L/ FAX CONTRACTOR NAME LICENSE NUMBER LICENSEE TYPE BUS.LIC.# t PANY NAME _ E-MAIL FAX //ET ADDRESS/ � + ;r CITY,STATE Z-1 PHONF�V:. �% `fir I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. An inspection request shall be scheduled the day before the inspection date. Please call (408)777- 3228 between 7:30 - 3:30pm (Mon-Fri) to schedule the next day inspection. 3. After the roof is torn off and the nails/fasteners have been removed and all the dry-rotted wood has been replaced, you must call for a roof inspection. A building inspector will be available with one hour. There are special hours for the service: 7:30 — 10:30am and 1:00 — 3:30pm (Mon—Thurs); 7:30 — 10:30am and 1:00 —2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection is required. 5. New roof coverings shall not be applied without first obtaining all inspection and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 6. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. To receive a final sign-off, the following item will be verified: a. Flat roofs shall have a minimum of 1/4" per foot of slope and demonstrate there is no ponding. b. A listing from an approved testing agency shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 7. NOTE: If you call for a plywood nailing inspection and the job is not ready, you will be charged to a re- inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. 'Zy my signature below, I certify to each of the following: I am the property owner or authorized agent to act on ..ie property owner's behalf. I understand and agree to comply with the re-roof policy stated above. Signature of Applicant/Agent: _ Date: ReroofPolicy_2010.doe revised 04/14/10 M.Indoor Air Quality and Finishes 1.Use LowNo-VOC Paint 1 IAOIHealth pts y=yes 0 2.Use Low VOC,plater-Based Wood Finishes 2 IAD/Health pts y=yes D 3.Use Low/tdo VOC Adhesives 3 IAD/Health pts y=yes D 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IAQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAO/Health pts y=yes D 7.Seal ail d t'�sa' kbDard or MDF _ 4 IAQ/Healih-pts = es D B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAC YHealth pts y=yes D i i 6 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes D 2.Use Rapily Benewable Flooring Materials 4 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAC)/Health pts y-=-yes D 5.Use Exposed Concrete as Finished Floor "RBSDUMS y=yes 0 6.Install Recycled Content Carpet with Low VOCs y=yes 0 1 R E Total Points Available:j 1 1401 1301 57 Total Points Project Received: =-- 0 0 0 �.i G-datalpr slgreenbuildnoguidelines/remodelers/greenpointsnnal2.12.64proteDted.xls CITY OF CUPERTINO 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35611064 . 00 DATE ISSUED. . . . . . . : 04/22/2010 RECEIPT #. . . . . . . . . BS000010242 REFERENCE ID # . . . : 10040139 SITE ADDRESS . . . . . : 921 LIBERTY CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . PETER WANG ADDRESS . . . . . . . . . . : 921 LIBERTY CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4018 RECEIVED FROM . . . . : PAT ANSUINI CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 15, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 15, 000 .00 1 . 50 0 . 00 1 .50 0 . 00 1REROOFRES SQ FEET 17 . 00 221 . 00 0 .00 221 . 00 0 . 00 1SKYL<10SF EACH 1 . 00 380 . 00 0 . 00 380 . 00 0 . 00 1SUPINSFEE HOURS 1 . 00 126 . 00 0 . 00 126 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 771. 50 0 . 00 771 . 50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF